Veterans' Mysterious Maladies

As soldiers return home after tours in Iraq and Afghanistan, many look forward to enjoying the simple pleasures of a “normal” life again. But complicating this readjustment to the daily routine are the lingering pains of war some combat veterans experience. Not only can there be residual physical injury or mental stress, some ailments have no definition, leaving diagnosis and treatment options scarce.

“On the outside, I look perfectly healthy. On the inside, my body is literally destroying itself,” testified Melissa Sterry, a veteran of Desert Storm, before the Connecticut Select Committee on Veterans’ Affairs in February 2005. “From blood in my urine to blood in my stool, to upper respiratory infections, to chronic pneumonia, to myriad medications. At the age of 29 I could run two miles in 16 minutes and 8 seconds. ... At the age of 30, I can’t walk around the block.”

Since the Persian Gulf War of the early 1990s, inexplicable ailments from chronic fatigue to memory loss to nervous system disorders have been studied in connection with exposure to hazardous agents during service. Of the nearly 700,000 U.S. troops who served in the Gulf War, more than 100,000 have registered health concerns with the Department of Veterans Affairs or the Department of Defense. Of those, 15,000 reported symptoms that could not be diagnosed.

Studies continue today on potential exposures of U.S. Armed Forces and National Guard members returning from the Middle East to such things as vaccines and medications to smoke from burning oil wells to materials used in the very weapons and shielding meant to protect the troops. One substance unique to combat since the first Persian Gulf War, and on the radar screens of at least 20 states in 2007, is depleted uranium.

Depleted Uranium
Lingering illness from service in war is not new. “Thirty years ago, returning Vietnam veterans were reporting symptoms that were later found to be caused by Agent Orange,” says Wisconsin Representative Tom Nelson. “Today’s veterans are reporting similar life-threatening medical symptoms, caused not by Agent Orange but by another substance, depleted uranium.”         

Depleted uranium is a toxic heavy metal that is 40 percent less radioactive than naturally occurring uranium. It is a by-product of enriching uranium to create nuclear reactor fuel or weapons-grade material. It was first used in battle in 1991, and is very dense, making it attractive for tank armor and munitions. Service members are exposed to depleted uranium by inhaling or ingesting its dust after the metal is struck or its shrapnel fragments are lodged in the body.

Veterans Affairs, the Department of Defense and Congress have funded scientific studies on the health effects of exposure to chemical, biological and environmental agents related to military service. The National Academy of Sciences examined possible health effects of depleted uranium exposure from the first Persian Gulf War, and reported in 2000 that poor medical recordkeeping and limited environmental monitoring hindered finding definitive answers. The Committee on Health Effects Associated with Exposures During the Gulf War was not able to find evidence linking uranium exposure to kidney disease or—at low exposure levels—lung cancer. The evidence was insufficient to determine whether exposure to depleted uranium could be associated with other health problems, including lymphatic and bone cancers, nervous system and respiratory diseases, and reproductive or developmental dysfunction.

In 2008, another National Academies committee concluded, as the Army had in a 2004 study, that kidneys are the most “sensitive target” of uranium toxicity, but that “evidence on the risk of cancer or other chronic diseases … is inadequate.”

Studies continue in the United States and abroad on the long-term health impacts of depleted uranium, with particular attention to its effect on the kidneys, lungs, central nervous system, reproductive system and genetic mutations.

Guidance on Exposure
The Department of Defense has attempted since 2003 to manage the clinical care of veterans exposed to depleted uranium. The strategy includes “training and education, clinical treatment and medical surveillance, post-deployment screening, health risk communications and medical follow-up in conjunction with Veterans Affairs.” The department is pushing for proactive identification of exposed veterans and detailed recordkeeping and archiving.

Work at the federal level continues, including congressional authorization to study further the health effects of exposure and the potential carry-over to children of service members. Despite these efforts, many state legislators have heard frustration and fear from veteran constituents and their families about inadequate acknowledgment and care by the federal government for undiagnosed illnesses resulting from their service.

State Action
State governments spend more than $3.5 billion each year to support veterans and their families, according to the National Association of State Directors of Veterans Affairs. States may also assist national efforts by informing returning veterans of federal services and helping increase the level of participation in medical research.

Legislatures in California, Connecticut, Louisiana and New York were the first to pass bills to assist combat veterans in obtaining federal health screening tests, report on the scope and adequacy of pre-deployment training on exposure to depleted uranium (and the feasibility of adding such training if found to be lacking), and convene task forces to study the health effects of exposure to toxic chemical substances.

The Wisconsin Legislature passed a law sponsored by Representative Nelson that informs veterans of depleted uranium exposure and federal health screenings, and establishes a study committee.

Both chambers in Hawaii have adopted resolutions requesting that combat veterans be informed about depleted uranium exposure, that training be evaluated and that the chemical’s storage and disposal at military installations in the state be investigated. Lawmakers have asked Hawaii’s congressional delegation to obtain Department of Defense help with these measures.

Statehouses introduced approximately 50 bills on depleted uranium last session. At least nine states passed legislation requiring action on outreach, training, data collection and research.

Beliefs differ among legislators about the role states should play in promoting federal programs. During the last two legislative sessions, Arizona Representative Albert Tom has attempted to pass legislation that would require his state to help veterans obtain federal health screenings for depleted uranium exposure. These attempts have been unsuccessful for several reasons, and Tom believes expense is a factor.

State legislatures continue to study the issues facing combat veterans who are trying to reclaim their pre-war lives and responsibilities.

Connecticut Senator Gayle Slossberg would like to see states work together on health registry compacts to build the data on combat veterans’ exposure to toxic substances, environmental hazards and vaccinations related to their service. Participant medical data would be tracked according to a member’s particular service overseas, and cases could be compared to discover correlations between the type and location of service and the resulting health effects. Slossberg says it is imperative to “increase the body of evidence on combat-related health issues to foster greater action at the federal level.”

CHECK OUT: A chart of the more than 50 bills related to depleted uranium that were introduced in the states last year at www.ncsl.org/magazine.

Early Congressional Action
The Veterans’ Health Care Act of 1992 (PL 102-585) established the Persian Gulf War Veterans Health Registry. It requires the secretaries of Veterans Affairs and Defense to contract with the National Academy of Sciences to review the health consequences of service.

The Veterans’ Benefits Improvements Act of 1994 (PL 103-446) a.k.a. the Persian Gulf War Veterans’ Benefits Act, addresses compensation for Gulf War veterans suffering disabilities from undiagnosed illnesses. The act requires the secretary of Veterans Affairs to develop case assessment strategies to define and diagnose illnesses, and promotes greater outreach to veterans on research, services and benefits. Benefits were expanded in a 2001 amendment.

The Veterans’ Programs Enhancement Act of 1998 (PL 105-368) requires improvements to health care eligibility, effectiveness and analysis of Gulf War veterans. The act established a national center for the study of war-related illnesses, and requires the secretary of Veterans Affairs to contract with the National Academies to research the consequences of exposure to biological, chemical or other toxic agents, environmental or wartime hazards, and preventive medicines or vaccines.